The article, “Contracts for new ambulance firm raise questions” (Star-Advertiser, Sept. 6), highlights several concerns with a newly bid contract for ambulance services that focus on the quality of emergency medical services (EMS) for Maui and Kauai. I believe it would be helpful to examine the experience of the state the last time a bid for Maui and Kauai ambulance service was carried out, in 1993-94.

Thirty years ago, the Legislature had passed a new law requiring that most contracted services of significance be put out to bid. As ambulance service was and is a critical medical service subject to the law, maintaining its quality is thus key to any bidding process.

How do you address quality in a bid process? The state Department of Health (DOH) got input from all parties to the process, including legislators from both Maui and Kauai, as well as ambulance staff and the affected hospitals. It carried out regular communications with all parties and exchanged ideas with those involved. This was critical to trust, as well as the quality of the final product.

The first major component of the solution was to secure the workforce. The bid required any contractor, new or old, to use the currently existing workforce for all but the very top management jobs. This eliminated the concerns with quality that a wholesale restaffing would entail and satisfied the mobile intensive care technicians (MICTs, or paramedics) and emergency medical technicians (EMTs) that their jobs were not on the line with this change.

Secondly, the department added a level of quality review for each bidder. A committee of emergency department staff (medical doctors, nurses, etc.), emergency personnel (MICTs and EMTs) from Oahu and Hawaii, and experts on EMS from across the state was formed to create standards by which bidders would be evaluated (response times, operations, etc.). These standards were incorporated into the bid process itself. Before a financial bid could be opened, a bidder had to pass the quality standards. Each bidder selected one of their operations on the mainland to be rated and the quality committee members visited the sites and evaluated each.

The result: Both the competing bidders passed the quality review. American Medical Response submitted the lower bid, and won the contract. The new contract saved the state over $1 million a year.

What are the lessons for the present situation?

First, regular communications with all parties affected by ambulance service is critical, and it behooves the DOH to engage with these parties. Listening is essential, as is unbiased evaluation of suggestions. An advisory committee such as that used in 1993-94 would be a great mechanism to use, if one is not already constituted. The people most affected are essential to solutions that will work effectively over time.

Second, means that assure the quality of such an essential service as ambulance service are important to any bidding process. Establishing measureable quality standards prior to the bid will not only ensure that the public can be confident in the winning bidder, but will aid in oversight of the contract once the bid is awarded.

Finally, regulations sometimes have unintended effects. In 1992, a regulation to open up EMS staffing to mainland-licensed personnel to alleviate staffing shortages was seen to threaten quality in ambulance service if used inappropriately by a potential bidder. A consequent amendment to the bid process was made to prevent misuse of the regulation. Similarly, a regulation allowing for flexible staffing of advanced life support personnel might be appropriate for a jurisdiction where elected officials are ultimately responsible for service delivery, but inappropriate for a for-profit private contractor. Clarification might be helpful today, as it was in 1993-94.

We all want the best publicly funded services for all that government does. For ambulance services this is critical, especially as we face the challenging situation on Maui, which dictate the best possible ambulance services during the island’s recovery.

Peter A. Sybinsky, Ph.D., was deputy director of the state Deparment of Health, responsible for overseeing DOH’s EMS program the last time it was bid in 1993-94; he is now retired.